sensory & motor testing including reflexes, coordination & balance

Motor examination:

  • to detect the presence of a CNS lesion causing extremity weakness:
    • the simplest, most rapid & subtle test is for “drift”:
      • the sitting patient is asked to close his eyes & hold his arms out horizontally with palms up for 30secs.
        • if weakness is present, the hand & arm on the affected side will slowly drift or pronate.
      • lie pt prone with knees bent 90deg. and legs pointing vertically up for 30secs
        • a weak leg will tend to drift & drop
    • another sensitive test for extremity weakness is hand grasp, & foot plantar and dorsiflexion
      • test hand grasp using both hands with examiner's hands crossed in front of him so that one can test pt's ulnar side which is more reliable than radial aspect.
  • if abnormal results or peripheral nerve or muscle injury, then more formal testing is needed.
documentation of muscle strength
scoreresult of testing
4+Slightly less than full power against strong resistance
4Able to overcome moderate resistance
4-Able to overcome mild resistance
3Able to accomplish full ROM against gravity
2Able to accomplish full ROM with gravity eliminated
1Only trace muscle contraction, may only be palpable

Sensory examination:

  • as with other aspects of the neuro. exam., if abnormal findings or specific symptoms then more detailed testing is indicated.
  • testing for pain sensation is best done by double simultaneous stimulation (as for trigeminal nerve)
    • to exclude CNS lesions, if testing on dorsum of hands & feet is normal no further testing for pain is needed
  • double simultaneous stimulation with gauze or wisp of cotton wool can be used to test light touch
    • NB. light touch is usually spared in unilateral spinal cord lesions
  • testing for isolated nerve injuries:
    • 2 point discrimination with paper clip ends, normal is 2-8mm on fingertips & up to 75mm on upper arm & thigh
  • proprioception is the most sensitive & easiest test for post. column pathway deficits
    • move great toe up or down & ask pt which way you moved (upper limb not usually needed to be tested)
  • stereognosis is dependent on touch & position sense as well as post. column & sensory cortex function:
    • ask pt to identify a familiar object placed in palm (eg. key or paper clip)
  • vibration sense is often the 1st sensation lost in peripheral neuropathies such as alcoholism or diabetic:
    • place vibrating tuning fork over DIP jt of a finger & the great toe, ask pt to tell you when vibration disappears.
    • if sense is absent, move to a more proximal joint


  • document as: 0 = absent; 1+ = diminished; 2+ = normal; 3+ = hyperactive; 4+ = hyperactive with clonus;
  • symmetric hyporeflexia may be normal or due to sedation, hypercalcaemia
  • asymmetric reflexes indicate neurologic or muscular dysfunction.
  • to evaluate the L4-5 nerve root (as in disc prolapse) test power of extensor hallucis longus
  • +ve Babinski reflex (up-going plantar reflex) indicates an upper motor neuron lesion
reflexes and their spinal cord levels
Upper ExtremitylevelLower Extremitylevel
TricepsC7 (8)HamstringsL5-S1
Upper abdomenT6-9BulbocavernosisS3-4
Lower abdomenT10-12Anal winkS3-5

Coordination and balance:

  • cerebellar function:
    • place finger on nose test with each hand & eyes closed (or finger to examiner's finger then to pt's nose, eyes open)
    • heel-to-shin testing with each leg (ankle to knee and back again)
    • rapid alternating movements eg. touch each fingertip with thumb; supinate/pronate hand; tap floor with foot;
  • balance is a function of vision, vestibular sense and proprioception, 2 must be intact to maintain balance:
    • Romberg test - stand with feet together
      • pt with vestibular deficit will report vertigo
      • close eyes if proprioceptive deficit, pt will sway ⇒ +ve Romberg's
    • tandem gait (heel-toe walking) is sensitive but not specific test of balance.
n_exam_sensorimotor.txt · Last modified: 2023/11/01 02:48 by gary1

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